The New York Times - November 4, 1986
Erik Eckholm

In a report by the Institute of Medicine of the National Academy of Sciences, a panel of the country's leading medical researchers said Federal funds for AIDS research should quadruple in just four years - to $1 billion in 1990. It also called for measures to draw more scientists from universities and private industry into the battle.

In interviews in recent days, several panel members and other scientists elaborated on their frustrations with the current research effort.

"Not enough is being done," said Dr. Sheldon M. Wolff of Tufts University, cochairman of the institute committee that wrote the report. "There are important questions that could be attacked if more money were available."

Panel members said that science has made spectacular progress in identifying and describing the virus that causes acquired immune deficiency syndrome. Their report stressed, however, that advances to date were "only the beginning of what promises to be a long and difficult path" toward the design of effective treatments and a vaccine against AIDS.

The panel members also asserted that even though the AIDS research budget has already climbed dramatically, the need to meet practical requirements such as tracking the spread of the disease and testing potential drugs has shortchanged more fundamental studies.

Advances in knowledge of the AIDS virus, far from producing a cure, have opened up new lines of investigation. Vast ignorance remains, for example, about how the virus infects the body, how it causes disease and why it affects some people and not others. More study is needed of the nature of retroviruses generally and of the subgroup to which the AIDS virus belongs. Basic work on the immune system, which the virus cripples in some infected individuals, is vitally needed as well.

Far more can be learned by studying the action of closely related viruses in monkeys, and some scientists even dream of creating genetically altered mice that can be infected with the AIDS virus, a development that would ease many key tasks.

Not too many months ago, some scientists such as Dr. William Haseltine of Harvard University, a leading virus researcher who was not on the institute panel, publicly bemoaned what they perceived as a paucity of top scientists investigating AIDS.

But things have changed quickly, Dr. Haseltine said in an interview last week. "There's now a tremendous desire on the part of the research community to get involved," he said. As the research effort matures, he said, "people are beginning to see opportunities within their specialties" for useful work on AIDS. "More and more scientists now see how they can apply their talents."

Experts point to several specific constraints on research, including the scarcity of "containment" facilities where work with the virus and infected animals can be conducted safely, inadequate supplies and distribution of AIDS virus components and shortages of funds for training young scientists and for critical equipment. They also say that industry fear of liability suits is inhibiting vaccine research.

Changes in law or policy can ease some of these difficulties but, as Dr. Wolff observed succinctly, "The key is the money."

The institute's panel endorsed the request, already drawn up by health officials but not yet accepted by the Reagan Administration and Congress, for a doubling of AIDS research funds to $471 million in 1988, from $244 million in 1986. But it said twice again as much money, $1 billion a year, could be put to productive use by 1990.

Still another billion dollars would be necessary for public education and prevention, the panelsaid. Lapses in the education effort received its sharpest criticisms.

A particular concern was the declining share of Federal AIDS funds for independently initiated proposals from university scientists. As clear needs for applied work such as drug trials rose, the National Institutes of Health increasingly assigned contracts for studies it had already designed rather than soliciting new proposals and ideas from the outside.

"The best way to bring out initiative and imagination is to allow people to think up a hypothesis and submit a grant proposal," said Dr. Irving Weissman of Stanford University, a member of the panel.

Dr. Anthony Fauci, who as director of the National Institute of Allergy and Infectious Diseases manages a large share of the Federal AIDS budget, said he shared the concern but that major increases in the share of investigator-initiated studies were already in store. He said that a rise in contracted work had been unavoidable as officials sought to direct research toward promising drug therapies.

But some experts remain worried that funds for basic exploration will be squeezed.

"We found a paradox that's really quite frightening," Dr. Weissman said. "At a time when funds for AIDS research are increasing rapidly, money is being moved away from areas of fundamental research that could ultimately give us knowledge for better treatment. People who used to be funded in basic immunology and retrovirology found that the money was no longer there."

In a related concern, scientists have objected that a portion of the increase in AIDS funds was diverted from other important biomedical research. The billion dollars called for by 1990, the institute panel said, should be "new" money.

The payoffs of basic research on viruses and the immune system are unpredictable and likely to extend well beyond AIDS, scientists say. For example, the huge investment in the late 1960's and 1970's in virology as part of the so-called war on cancer has often been castigated as wasteful. Yet experts observe that it was those past investments that permitted the quick identification of the AIDS virus when the mysterious new disease appeared in the 1980's.

In its report last week, the Institute of Medicine highlighted the complexities confounding development of an AIDS vaccine and charged that Federal coordination of efforts in government, universities and industry had been inadequate.

The panel also urged the Federal Government to find a way to reduce companies' worries about liability in the testing and use of potential vaccines, which may have kept many firms out of vaccine research.

In the development and testing of new drugs, perhaps more than any other area, "money equals speed," Dr. Haseltine said. As the understanding of the virus improves, so does the chance, he said, for actually designing chemicals that will fight it rather than searching in a scattershot way for existing drugs that can be used against it.

A major impediment both to basic studies and to development of drugs and vaccines is the absence of good animal models. Chimpanzees are the only animals known to become infected with the AIDS virus butonly a few hundred are now available for AIDS research and these, the institute report stated, "must be treated as an endangered national resource that will be irreplaceable if squandered." Imports of wild-caught animals are not allowed because chimpanzees are threatened in Africa.

More plentiful monkey species catch an AIDS-like disease from a closely related virus, and scientists hope that expanded research on this will provide answers about AIDS. Some, such as Dr. Weissman, think it might prove possible to alter the genes of a mouse so it can be infected with a modified AIDS virus, providing an even better animal model.

Social science research that would help prevent the spread of AIDS is perhaps most neglected of all. Panel members were astounded, said Dr. Leon Eisenberg of Harvard University, to find that the Kinsey Report of the 1950's was still a key source on the extent of homosexuality. And little is known about what kinds of information in what forms actually spur people to change their behavior to avoid disease.

Panel members say there is no contradiction between their calls for more independently designed basic research and for a National Commission on AIDS to guide research and prevention activities. They did not envisage an AIDS "czar" who would direct all research; "no one is smart enough for that job," Dr. Eisenberg said. Rather, the panel saw need for a small group to review developments in and out of government, identifying opportunities that are emerging and opportunities that are being missed.

The AIDS epidemic, which has already brought fatal disease to 27,000 Americans and a dangerous infection to more than a million, threatens to become an even greater catastrophe, the expert panel warned. Nor do the scientists believe the disease can be defeated in a few years, which is why they called for 'perhaps the most wide-ranging and intensive efforts ever made against an infectious disease."

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